Extracorporeal Life Support in Infarct-Related Cardiogenic Shock

To the Editor: In the ECLS-SHOCK trial, Thiele et al. (Oct. 5 issue) 1 compared early extracorporeal life support (ECLS) plus usual medical treatment with usual medical treatment alone in patients with infarct-related cardiogenic shock and found no significant between-group difference with respect to death from any cause at 30 days. However, the extremely low incidence of mechanical discharge (5.8%) in the ECLS group may have provided nonoptimal left ventricular unloading and potential cardiopulmonary overload with an associated dismal prognosis. 2 Alternatively, these patients might have been assigned to receive ECLS too early or did not require ECLS at all, as highlighted . . .